High Ki67 predicts unfavourable outcomes in early breast cancer patients with a clinically clear axilla who do not receive axillary dissection or axillary radiotherapy

S. Zurrida, V. Bagnardi, G. Curigliano, M. G. Mastropasqua, R. Orecchia, D. Disalvatore, M. Greco, L. Cataliotti, G. D'Aiuto, N. Talakhadze, A. Goldhirsch, G. Viale

Research output: Contribution to journalArticle


Aim Axillary dissection is increasingly forgone in early breast cancer patients with a clinically negative axilla. The GRISO 053 randomised trial recruited 435 patients of age over 45 years, tumour ≤1.4 cm and clinically negative axilla, to assess the importance of axillary radiotherapy versus no axillary radiotherapy in patients not given axillary dissection. In the present study on a subgroup GRISO cases our aim was to assess the prognostic importance of tumour biological factors after more than 10 years of follow-up. Methods We retrospectively assessed biological factors in a subgroup of 285 GRISO cases (145 given axillary radiotherapy; 140 not given axillary radiotherapy) with complete biologic, therapeutic and follow-up information, using multivariable Cox proportional hazards regression modelling. Results Only 10-year cumulative incidence of distant metastasis was lower in the axillary radiotherapy (1%) than no axillary radiotherapy arm (7%) (p = 0.037). Irrespective of study arm, hormone receptor positivity had significantly favourable effects on 10-year disease-free survival (DFS) and overall survival. human epidermal growth factor receptor 2 (HER2)-positive and triple-negative subtypes were associated with lower 10-year DFS (60% and 76%, respectively) than luminal A (96%) and B (91%) (p = 0.001). Ten-year DFS for high (≥14%) Ki67 cancers was lower than for low Ki67 cancers (p = 0.027); however, this effect was mainly confined to the no axillary radiotherapy arm. Concluding statement For patients with clinically node-negative small breast cancer not given axillary dissection, 10-year DFS is worsened by HER2 positivity, triple-negative phenotype and high Ki67. Axillary radiotherapy counteracts the negative prognostic effect of high Ki67 in patients not receiving axillary dissection.

Original languageEnglish
Pages (from-to)3083-3092
Number of pages10
JournalEuropean Journal of Cancer
Issue number15
Publication statusPublished - Oct 2013



  • Axillary dissection
  • Axillary radiotherapy
  • Early breast cancer
  • Ki67

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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